He’s biting again

“Mr. V is biting again.”

“God, what are we going to do with him?”

“I don’t know, but he’s getting too much to manage…”

Dementia is a debilitating disease. It creeps up slowly, crouches for attack, and seems to suddenly wipe our lives from right beneath our feet.

Many of us have had loved ones stricken by the disease, and have watched in muted horror while the person we knew vanishes, as we wonder, “if it’s this bad for us, what must it be like for them?”

I was working in an emergency department in Ontario, Canada, when a gentleman, Mr. V, was brought in from his place of residence when staff determined he was too agitated for their care. On arrival, he could not speak beyond muttering a few nonsensical words, and would randomly grab at staff as they walked by, seemingly on a completely random basis. The staff at his residence confirmed he had a history of dementia.

These sort of patients are difficult for a variety of reasons. The inability to communicate often results in subtle needs going unmet, leading to aggression. They require a high level of nursing resources to manage. And the fact is, our healthcare systems in Canada (particularly emergency rooms) are not equipped to properly care for people with dementia (in fact, in many ways they are perfectly equipped to exacerbate symptoms of aggression in dementia).

I began to work with Mr. V and I immediately noticed his age – he was in his late fifties. This is a fairly young age to develop dementia and immediately the differential changes. Could he have some rare form of genetic Alzheimer’s, which can affect people at  that age?

The second thing I noticed was has last name, changed for the purposes of this blog. The spelling on the name was immediately suspicious for someone of Sri Lankan descent. I phoned Mr. V’s emergency contact, and my suspicions were confirmed. Mr. V had a long history of alcohol abuse, and had subsequently developed a dementia. He had been various degrees of under-sheltered for the last number of years. He had immigrated to Canada some decades prior, as a refugee. Mr. V was Tamil and had been a victim of unnamed trauma during the Sri Lankan civil war.

Credit: Alternative Press

I won’t go into details here, but the Sri Lankan civil war (1983-2009) was your typical civil war cocktail of genocide, torture, rape, and any number of unspeakable deeds. The effects of civil war and genocide on the human brain are well documented and not easily conceptualized. Obviously it has a tremendous impact on people, Mr. V being the latest example of a casualty of the war. The United Nations recently reported that one in five individuals in conflict zones suffer from a major mental illness, at any given time.

What struck me about this story was how succinct it was. The clear relationship between this man’s trauma, alcohol use, and dementia. The story isn’t always that clear. But there’s always a story. Next time you meet someone with an alcohol problem, dementia, or any other mental illness, stop and think, there’s more to the story.

 

Editor’s note: What happened to Mr. V? We uncovered an acute medical problem that was easily treated, superimposed on his dementia, and he returned to his baseline after a couple of days of treatment!

 

Dr. Travis Barron is a resident physician in the Department of Psychiatry at the University of Toronto in Toronto, Canada.